April 14, 2024


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‘The American model’: Ontario doctor claims move to private care building steam

Dr. David Barber, chair of the Ontario Medical Association’s general and family practice section, says a move toward private health care in Ontario is “happening already” and that it’s “going to get worse.”

During a news conference Thursday discussing a shortage of family doctors in Ontario, Barber said one of his own patients went to Montreal and paid about $2,000 for a test that had a roughly 12 month wait-list in Ontario.

He also highlighted the growing number of nurse practitioner clinics in the province, which charge patients for services directly rather than through the Ontario Health Insurance Plan (OHIP). One such clinic in Hamilton has service prices ranging from $80 to treat a sore throat to $240 for a comprehensive mental health assessment.

“We are heading in that direction, there’s no doubt about it. We are heading towards the American model,” Barber said.

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Ministry of Health spokesperson Hannah Jensen said it is a “violation of the Commitment to the Future of Medicare Act (CFMA) to charge an individual for an OHIP-insured service or a component of an insured service.” She added that if a patient feels there has been a violation, they can contact the CFMA program by calling 1-888-662-6613 or emailing [email protected].

“The ministry reviews all possible violations that come to its attention and ensures that all OHIP-insured patients who are charged for an insured service are reimbursed in full.”

She noted that, in a push to connect those without family doctors with primary care services, the government has provided $50 million “each year to connect hundreds of thousands of Ontarians to primary care through 25 nurse practitioner led clinics across the province.” The government’s web page on nurse practitioner clinics says “there is no fee for this service.”

However, services delivered by nurse practitioners, who are not part of provincially funded nurse practitioner-led clinics, are not covered by OHIP. In recent months, multiple news outlets have reported examples of nurse practitioner-led clinics charging patients across Ontario.

Click to play video: 'Ontario clinic direct billing for healthcare highlights grey area around nurse practitioners'

Ontario clinic direct billing for healthcare highlights grey area around nurse practitioners

According to the OMA, which represents doctors in Ontario, 2.3 million Ontarians were without a family doctor as of the end of January. By 2026, 4.4 million Ontarians are expected to be without a family doctor, or roughly one in four Ontarians.

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Barber suggests patients who currently have a family doctor ask their physicians what their retirement plans are or if they plan on leaving family medicine.

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Two doctors who made the decision to leave their family practices shared their stories Thursday, citing lack of funding, a growing administrative burden and burnout as major factors.

Dr. Natalie Leahy closed her family physician’s office in Oshawa, which she opened in 2007, last fall.

She said billings to OHIP have been capped, cut or increased by just one per cent over the last decade. Operating a family practice is a small business, she said, and she has to pay for overhead and staff before paying herself.

To help make ends meet, she took on an extra job, spending one overnight a week in hospital.

Outside of funding issues, Leahy said the administrative burden has ballooned and she’s “not talking about patient charting.”

For example, she said the Canada Revenue Agency disability tax credit form went from six pages to 16.

A lack of a centralized referral system would also see her reaching out to three or four specialists before finding one able to see any patients needing specialized care.

Eventually, after having to take some time off to care for her dying father and a sick child, she decided that for her own well-being and the well-being of her family, she had to leave family medicine.

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She also warned that fewer medical students are choosing to go into family medicine, noting that when residents she worked with finished their residency, they were not choosing to set up practice.

Coming with significant debt from medical school, residents “knew it would be a failed model from the beginning,” she said.

That’s a sentiment Dr. Dannica Switzer shares. She was with the Wawa Family Health Team before she also chose to leave family practice last year.

“We cannot recruit our way out of a retention problem,” she said.

Switzer shed light on the needs in northern Ontario. She said a recent government assessment concluded that it would take seven doctors to properly serve the community. Currently, there are three.

“The contract that we work under, which was last updated in 1996,” she said, “it simply falls to whatever doctors are in town to do all the work.”

She says she now works part-time, choosing when, where and how much she works, and spent five weeks working in Wawa in November and December 2023.

The province, meanwhile, says the government is making “record investments in our publicly funded healthcare system” including $80 billion this year alone.

In addition to the 25 government-funded nurse practitioner-led clinics, Jensen also pointed to a “recently announced, historic expansion of interdisciplinary primary care teams.” Earlier this month, Health Minister Sylvia Jones announced the province is providing $110 million in an effort to connect more than 300,000 people to primary care teams.

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— with files from Global News’ Don Mitchell and The Canadian Press’ Liam Casey.

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